Post-Treatment Collateral Damage: Long Term Side Effects

Okay.Leah?Yes,Tina.I'm gonna go with this on a desert island kind of question.If there was only one thing that you could advise people to do after treatment for cancer,any cancer,any treatment to improve their day-to-day living,or what we call in medicine,their quality of life,what would it be?What's the one thing you would recommend?For anyone and everyone across the board?I would say exercise.All right.And I,I don't mean like the same exercise for everyone,for one person it could be yoga for someone else,it could be,weightlifting or Zumba or whatever,but just some sort of deliberate movement.Yeah.Evidence weighs heavily on the side of movement and exercise being beneficial across the board for everyone at all times.Yes.Makes sense.What would yours be if it wasn't exercise?If if,because I took exercise is my answer.Yeah.Thanks a lot,Um,what would yours be?I think.on the heels of exercise,I would put stress management.Ooh,that's a good one.That's a hard one.That's a hard,people think exercise is hard,but stress management is hard.Yeah.Yeah,it is.Exercise is more clear cut.I mean,you're either doing it or you're not.You're moving or you're not kind of thing.But stress management is tough because it changes and you're not in control of the incoming stressors of life.So yeah,I think stress management is much tougher in the grand scheme.So stress is very subjective.And one thing that I've been recommending a lot lately is just different breathing techniques.Mm-hmm.and I don't necessarily like frame it as,this is stress management.um,I guess I kind of do,but I guess,you know,I say like,oh,if you have trouble sleeping or if you're feeling anxious.I don't necessarily say for stress management,I'm just like,oh,you could try these breathing techniques.Right.a lot of people deny the fact that they're in a pressure cooker.Oh yeah,for sure.especially people who are in a lot of stress,they're so used to it.Right.I've always been this way.Right.This is,there's nothing different.Right.Yeah.So,and yeah,and I like the breathing because it's easy.I have patients who,for whatever reason,don't feel like they can exercise.And they probably need something more guided because of maybe other side effects that they have going on since completing treatment.Mm-hmm.or if they're in maintenance treatment,whether it's,you know,neuropathy or chronic pain or whatever it is,fatigue.Mm-hmm.And they're like,well,I can't exercise because of these side effects.Mm-hmm.But there are things that can be done if they could find someone to work with.And I think breathing is a great way to start.So give me an example.What kind of,give me a breathing exercise right now that our listeners could learn how to do.Well,my favorite one,which I actually did a little video a long,long time ago,uh,way back in the days of your Um,box breathing is one of my favorite things.I like to introduce it by saying this is something that the Navy Seals were taught to help them deal with stressful.moments.And I think for people who are very opposed to learning about pranayama or any sort of yoga breath or anything like that,I think you know,saying it that way is a little bit more approachable.oh,if the Navy Seals could do it,I could do this too.Sounds sounds pretty badass.Yeah,it's badass.Yeah.If you're badass,you're doing this breathing So box breathing is where through your nose,you inhale for the count of four and then you hold your breath for four,exhale through your nose for four,and then hold it for four.And then you just kind of repeat that until you start to feel relaxed.And so,it's something that people can do where if they were.stress management techniques.And they're like,I was told to clear my brain or you know,like,think about happy thoughts or whatever.And they're like,and I can't,I'm like,well try this breathing,because they're gonna start focusing on their breath.I don't necessarily tell them,focus on your breath.Mm-hmm.you just do.Mm-hmm.because you're like,oh wait,where was I?Okay,this is,you know,and it's just kind of a nice easy way of,um,incorporating breath.I like it as stress management.Yeah.I love box breathing.I use it all the time while you're talking.I've been doing it You were paying attention.You're just like,I'm breathing.I'm like,I'm half listening cuz I'm counting to four That works so well because that makes sense physiologically because your sympathetic and parasympathetic nervous systems are always Going back and forth,and you're either under the direction of one or the other.And when you do that type of breathing,you're kicking in your more relaxed side,your parasympathetic nervous system,rather than your sympathetic nervous system,which is in charge of your fight or flight,and your go,go,go.And those folks who call themselves type A personalities.So it makes perfect sense physiologically that calm breathing,box breathing kicks in your parasympathetics.Yeah,that's why I dig it.Yeah.I like it.Simple.It is simple and it,it's not a pill.You could take it wherever you are.If you,you know,feel like you can't move and exercise,you can,you can try breathing and somebody can't hold their breath for four,for whatever reason,Mm-hmm.just,you know,do it for what you can do comfortably.and you know what's kind of neat,and this keeps popping up on my social media because whatever searches,they're listening to us at all times.Um,there are these little stickers that you can buy that are like these kind of calming stickers.I'll try to look it up and we'll put a link in it.You can stick it on your laptop or on your water bottle and it's like a sensory thing and it's supposed to be very calming and they have some that look like little boxes.And so you could actually do that as you're breathing.I'll put a link.We'll put a link.Okay.And that cuz you're,you don't know what I'm talking about cuz you're not being stalked by ads.And you can see me.So you can see that I look baffled.You look baffled.Yeah.Yeah.It's,it's a cool thing.And I know someone who,who uses them and,and they like it.So,um,yeah.So that's another little stress management thing and that's what this episode's gonna be all about is,it's not stress management,but things that you can do for Maybe we should change it,maybe we should just do stress management.Yeah.Right here.No,no.We are,we're,we are talking about how to manage the collateral damage.Of cancer treatment.Mm-hmm.the lingering longer term things that still exist years after treatment is over.Yeah.Months,years,yeah.And what you can do about them.Yeah.So the reason we start with a universal,what would you do?Kind of one thing is we wanna make this as applicable across the board as we possibly can,but there's a lot to cover.So Yeah.Because different cancers,different treatments are gonna leave a lot of different,side effects.Mm-hmm.And so I feel like we tend to focus on breast just because it's a very common cancer and it's what I had.And so I wanna make sure that we are more inclusive,um,in our discussion.Mm-hmm.And then there was that article that,that just came out talking about the long-term risks of.cardiovascular disease and congestive heart failure up to20years after completing treatment with certain kinds of chemotherapy.Mm-hmm.and that's just like,ugh.One more thing,you know?Yeah,yeah.One more thing to worry about.Yeah.Yeah.The subgroup of people,I think of that this has been well-studied and are young cancer survivors,young people who undergo treatment,and by young we can talk about pediatric cancers and leukemias and lymphomas and young people or whatever.If someone is young enough to live another30or40years,this data has been out there for quite some time.Showing that,say for example,someone getting chemotherapy and or radiation for a pediatric leukemia and they get cured.So they're in their forties,they're in their thirties,forties,Their cardiovascular risk is many times higher than their peers who never one underwent that treatment.And this article focused more on,um,people who are getting treatment with Anthrocyclines.Mm-hmm.So that's like a specific category of chemotherapy that is used in a lot of different cancers.Um,breast cancer,gynecologic cancers,um,bladder cancer,stomach testicular,you know,I mean,so those certain subclasses that are so well known to damage given organ systems.So those anthrocyclines and cardiovascular damage.Is a real risk.And,you know,knowing that,I mean,the big thing I,I think people need to understand is sometimes,you know,those pediatric le leukemias are a good example of that treatment is lifesaving.You know,so you,you get to,have those decades of life because you got the treatment.At the same time,the treatment is incredibly toxic and can change the trajectory of your life eventually and give you a higher risk of stroke or cardiovascular damage in general heart attacks.Um,so it's,it's serious stuff and knowledge of it is helpful not just to,you know,be mindful of it because there's stuff we can do to lower the risk.I mean,risk reduction is where it's at with our medicine,with naturopathic medicine in general.I wanna say that because right up front,cuz I don't wanna talk about lingering side effects and just let people know that they're there and talk people out of doing treatment in the first place.I mean,there is something to be said for looking at the risk benefit at all times.And yes,the risk is long-term cardiovascular damage,but at least in the case of the young people who have leukemia,the risk is worth taking.And the same with lymphoma.I mean yeah.You know,patients with certain kinds of,um,you know,non-Hodgkin lymphoma.it's the same thing where the treatment is got such a,a success rate,but yeah,like one of these,one of these chemos is part of the,the,the regimen.So yeah,no,we're not gonna just sit here and do a laundry list of all the,all the things that linger.Cuz I think if you're listening you might know some of this stuff So it's more we're gonna talk about,um,just things in general to do.And,yeah,I think a lot of it will overlap when we talk about the things that you can do to,um,to support,especially with the cardiovascular part,to,you know,you're supporting your risk of recurrence as well as,um,supporting your different organ systems.Mm-hmm.that might be affected.So we mentioned cardiovascular disease,so should we go on and talk about what one could do very easily to lower the risk for that?Or would you like to just do an overview and then come back after the break-in?Break it down,break it down.

I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

and I'm Dr Leah Sherman and on the cancer inside

And we're two naturopathic doctors who practice integrative cancer care

But we're not your doctors

This is for education entertainment and informational purposes only

do not apply any of this information without first speaking to your doctor

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Welcome to the cancer pod

I guess we could keep going with the cardiovascular and then we'll just make sure that we,we touch on all the other organ systems cuz people are probably going like,what the heck?What am I listening to?This is doom and gloom.Yeah.We do not wanna be doom and gloom and there's no reason,no reason for that.Yeah.So we're recording this in February.I don't know when this is coming out,but we're recording it in February,which is also you know it's Heart Health month.Oh,is that right?Yeah.All right,good.Yeah,so there are a lot of um,articles out there right now on just kind of reducing your risk of cancer recurrence as well as,you know,reducing risk of cardiovascular disease.And like I said,a lot of that is overlap.So I would say one of my top things would be adopt a more plant-based diet.Mm-hmm.I agree.High on the list.Making sure you're getting lots of fiber,colorful foods.Yes.I know it's corny,but that whole idea of eat the rainbow is so true.And we're not talking Skittles.Don't you know,don't be thinking we're talking Skittles here.No,it's gotta be natural colors cuz it's the natural colors and the natural pigments that are the components that often have a benefit for your cardiovascular system and other systems too.And the,those colors can include shades of brown cuz that's your whole grains,that's your fibers,you know?Mm-hmm.Yeah.Cause often hidden the,and in the brown is some purple.You just can't see it very well.It's just like in the green,hidden behind some of the green is a lot of yellow.You just can't see it cuz it's hidden,but it's in there.So Luine,the purple.There's purple and brown.Oh,sorry.Yes,the pro am.I'm stuck on the purple I'm like,there's,so that means brown rice has got purple,I guess it would.Ooh,black rice.Mm-hmm.black rice is very purple.Um,yeah,so hidden behind some of the colors.So when you,when you do anything that hasn't been processed,obviously the color's still there from nature,it hasn't been stripped out A lot of times the color you're looking at is one color,but it's made up of multiple colors in nature to result in the color you see.So you have some blues and some reds and you're looking at a purple.But there are different compounds in that,in that food.Pro anthocyanins,polyphenols,flavonoids in nature.You know where the highest concentration of these are?The highest concentration of um,oh wait,I have to say,I have to say,no,Tina.Where are they?Well,the highest concentration of color is not gonna be surprising.It's in the petals of flowers.Eat more flowers.Well,you can,Natum are edible.There's plenty of flowers that are edible.Oh yeah,yeah.Don't randomly eat a flower,just know if it's edible or not.But they're kind of fun to grow if you have a garden,um,intersperse,you know,your vegetables with,and fruits with,with edible flowers.Absolutely.Because you know a lot of people,I would say the majority of people,when I ask them what vegetables they eat,a lot of people say salad,which is interesting.Everybody says salad.Isn't everybody that interesting?Everybody says,oh,well I eat salad,you know?Mm-hmm.And then if you ask what's in their salad,it's really not.that exciting.Sometimes it's not the salad that is chock full of different veggies.It's just a pretty basic salad.Which is fine.I mean,that's better than no salad at all.But you can really up the ante if you just look up and there's plenty of books on the topic,edible flowers that you can just put on the salad.It's gorgeous and it's very simple.And they generally have little flavor,not a lot of flavor in them.Maybe a little peppery.Yeah.Depends on it.Yeah.Yeah.Depending the stirum in particular.That's what I was thinking.But even garlic,if you're growing garlic bulbs,you know the,the flowers can be edible too.Oh yeah.Um,chives,chives,chive flowers.Those are bit,yeah,I eat those zucchini flowers.you know,you've got this,the Blossoms.Yeah.Mm-hmm.You can do all kinds of fun stuff with that.Yeah.Nice.So,um,I know that's odd.We should be talking more like straight up like blueberries and stuff,right?We should be like,oh,go ahead.Get your blueberries in your blackberries.And we give them so much attention and other episodes.I know.I think that's just it.So if you're listening to us for the first time,it's not because we're flower forward people.I can't believe you said that.That's awesome.It's that term that I hate that plant food.I know.I love it.I love,I love Uh,yes.This is in addition to all the good,um,basic stuff,foundational things that you're already doing in the diet with nuts and seeds and legumes and blueberries,blackberries,raspberries,strawberries,apples and oranges,and boys and berries.How many berries can I name?Gooseberries Marion Berries.Marion Marionberries.Hello,Oregon.Um,Yeah,so that's a huge part of it.The plant-based is huge and we kinda started off talking about exercise.I think exercise is really.You know,obviously really important.And then stress management.Yeah,all of these are really good for supporting against cardiovascular disease.What else you got in stress management?I mean,under the title of stress management and one thing that really can take a collateral hit during treatment is the,uh,what we call the H P A axis,the hypothalamic pituitary adrenal axis,which is a mouthful.Yes.That's why we call it H P A Um,but it really can take a hit.And here's Why I put it at the forefront of my thought process is if the H P A access is damaged,and by damage I mean thrown off its normal rhythm,the H P A access is responsible for waking up bright-eyed and bushy-tailed,and going into sleep and having a good,good solid night's sleep at night.So cortisol in particular,has a rhythm that makes it high in the morning through the afternoon,go down at night and it's nice and low during the night while you're sleeping,and that allows you to sleep.So it's kind of our bright-eyed,bushy-tailed hormone.This H p A axis is behind that,right?So if you've been living the past4,6,12months,however long in this constant state of I need to just get through this,survive and manage my life around me,um,you know,you're taking medications that disrupt sleep,whether it's steroids or whatever it may be.You've got side effects that are disrupting sleep.your appetite's not great.You know,all of this that's going on,it's gonna,um,it's gonna tweak that h p a axis.Yeah,a wee bit.Yeah.Because stress itself causes you to throw out more cortisol,and long story short,you can really monkey up the h p a axis rhythm over time between the stress and the steroids and everything you just said.And research has shown.if the cortisol is too high in the late day and evening in particular,it actually is correlated to higher rates of recurrence.So not only does it,you know,change your mood day to day,maybe lead to some fatigue or some anxiety,depending what's going on,it can also affect your recurrence rate.And so normalizing the H P A access is high on my to-do list in a long-term fashion because some of the things we talk about,which is like exercise can help normalize the H P A access.but it's so high on my list because it has to do with day-to-day how you feel,your mood,your fatigue level,all of that.And it can actually lower your risk of recurrence if it's normalized.So that's probably why I put stress management so high.No,I think that's great and I think that goes well with exercise cuz for some people exercise is stress management and for other people exercise is not So I think that,I think those two go really well together.Um,kind of going off of that,I would include just,just basic endocrine issues,whether someone has had their thyroid removed or partially removed,you know,that's gonna cause issues.There are,you know,treatments and surgeries that cause infertility.We've talked in previous episodes.hot flashes,um,you know,what they are,what to do about them.That's like episode one,two,and three.Mm-hmm.Yep.That's where we started.Yeah.We started with hot flashes.All began with hot flashes.Woo.Yeah.So,um,yeah.So that whole endocrine system is greatly affected.Yes.Cuz radiation to the head and neck mm-hmm.will affect the thyroid function.Of course.Anything having to do with,you know,removing the ovaries,having the prostate removed or immunotherapies,immunotherapies people can come out with,um,with having thyroid issues after,you know,like the treatment works great.Oh,great.You know,no cynic cancer and now they have thyroid issues.Yeah.And so many medications,intent.monkey up the hormone balance,right.So anti estrogen kind of blockade agents as well as testosterone blocking agents can both right the androgen therapies for prostate cancer.Yeah.So that's another area that should be its own episode.I was just gonna say,I think we should dedicate an entire episode to all of the issues that can arise with those sets of agents.Cuz I,I do think it's,you know,it's that catch22of I don't wanna take this medication,I have to take this medication feeling.And so that leads to stress as well.And so,you know,everything's kind of intertwined,I suppose.Yeah.And we've all had patients who refuse such agents,the anti hormonal agents and you know,that's a case by case basis.The risk benefit is different for every single person.Absolutely.I have a lot of,it's so interesting,depending on where one practice is in the country,but,um,where I am now,I have a lot of patients who are declining the androgen.deprivation therapy.Mm-hmm.because of potential side effects.And these are older patients,these aren't younger patients.And then where I was before,I had a lot of younger patients who were getting the androgen deprivation therapy,which I'm gonna just translate that as no testosterone circulating.Yeah.That's like Lupron,you know,those kinds of things.edX,Lupron,those,those,and then those kind of newer medications that are out there.But those are commonly prescribed for prostate cancer.And so I was dealing a lot more with those side effects when I was in Arizona than I am here,because patients are just,they're like,no,absolutely not.I'm not getting that.these are patients who are like in their late seventies and eighties,as opposed to it being somebody who's in their forties saying,no,I'm not gonna get it.So it's just really interesting.Right.Um,yeah,I will say that,you know,COVID is a bit of a third rail,but one thing that I.I do think has happened since the time of Covid is people are paying attention to individualization of risk benefit more than they used to.What I see coming back at me when I have conversations is,is there's an innate understanding of what someone does at78years old is different than what someone does at28years old.And they're like,oh yeah,of course.Like before I feel like I was revealing this idea to people as we spoke and looked at risk benefit.Okay.The risk benefit of this at your age,having,you know,a conceivably40more years on the planet or50more years on the planet is different than someone who has20more years or15more years.Oh,absolutely.Yeah.But what,what I'm seeing is the.What I'm seeing as somebody who would be like in their,in their eighties mm-hmm.saying like,no,I don't want those side effects.And they might not even be sexually active.They just don't want those side effects.It's really interesting.I think,you know,that's actually,we're gonna be saying this throughout the whole episode.That's a great episode on its own,is cancer care in the time of covid,because I'm also encountering a lot of people who are very adamant about certain alternative treatments.Mm-hmm.Mm-hmm.because they did their own research.Yes.And it's just,it's this,this weird thing because I didn't practice for a couple years and then Covid happened and now I'm practicing again and it's just this.Like it's,it's a whole,it's a whole nother episode.So we should keep going.Let's just keep going with our collateral da.But that's co that's the collateral damage of Covid There we go.Well,I think with Covid comes a little less trust in the authority of the system,so I'm just gonna,I'll leave it there.But I think that that's baked into the covid thing.Yeah.Okay.Is it like,love in the time of cholera,we'll have cancer in the time of covid?Yeah.Yeah.All right.Write that down.Write that down.Hold on.I got,I've got the pen.Now we gotta Oh,wait,should we take a break?Let's take a break and we'll come back and we'll pick up with some of the,um,kind of pick up from where we left off.we got more to say.Oh,we got a lot more to say.All right,we're back.And so we were talking about the endocrine side effects that happen.Um,long-term side effects from cancer treatment.And that kind of goes well with,I think about a lot of my patients who had gynecologic cancers and they had radiation mm-hmm.um,being put into because of surgeries,because of different treatments.Mm-hmm.has certain effects,but then actually getting radiation,to the vagina just causes a whole nother,set of side effects.And,you know,I I this make a great separate episode.Um,no,because there,there is a,you know,there are physical therapists who work specifically with people who have any sort of pelvic issues.Mm-hmm.um,you know,we could talk with different gynecologists or gynecological oncologists about different things that can,be supportive for patients.Yeah.Yeah.And the whole,the whole pelvic.Area,whether it's for prostate cancer,a gynecological cancer,anal cancer,rectal cancer,the effects are most severe,I think,in my experience,when they're going for a curative treatment.Right?So when cures on the table and the radiation is just,you know,we're talking really high dose,pretty aggressive,trying to get quote unquote every last cell.Yeah,the damage kind of is a distant second thought in some ways.And so curative radiation can be for.Some earlier stages of rectal cancer for anal cancer,for any squamous cell carcinoma that's in the area.So that's some cervical and vaginal cancers.And so I think of those scenarios as the most consequential long-term cuz with radiation,you're right,it needs a whole new episode cuz the damage due to radiation,the fibrosis of the tissue in the area is slow too.It's slow and it's over time,it's not just over with when the treatment's over with it actually takes years to really set in the full fibrotic process.And so fibrosis happens and there can be a narrowing of the anal canal and a narrowing of the vaginal canal.Certainly.And yeah,and dilators are one of the things.Are often prescribed for patients.I use vitamin E suppositories to help to soften the tissue.Depending on the cancer,there are,you know,like different hormonal,um,vaginal suppositories that can be used.And then the vitamin E suppositories can be used rectally as well.Mm-hmm.Um,so those,those are the big things that I think about Cula.Yeah.You know,I'm a big fan of the Cula teas,um,even during the time just to get relief if the radiation oncologist is okay with it.Oh,yeah.As a sits bath.Yeah.That's,or even a,the spray bottle.I think you're the one who told me about the spray bottle.Love the spray bottle.Patients love it too.Simple.Simple.I like the,I like when simple teas work go really well.Like,that's my favorite type of medicine is like,oh,this is super simple.Just do this and it works,and they can feel the difference.Symptom relief with an herb,love that.But that it can also continue beyond to help with,with healing the tissue even,you know.even later.So yeah,on that note,can we just,since we're on the top of cingulate tea,it can be useful for any area that undergoes radiation when,and you want some relief,it can be on the skin surface and there are some cingulate creams that radiation oncologists will even recommend.Certainly naturopaths recommend and good old cingulate tea.If it's in your mouth or it's in an area where you can make a sits bath and put your bum in there and soak,that's,that's fine.But it kind of is always indicated for radiation damage or radiation burnt to any area.And long term too,like you said.Yeah,cuz it's just so nice on the skin.Cula just for our listeners,CULA is a,is in the Marigold family Cula is a specific type that is medicinal.So,and it's very inexpensive and you can grow it in your garden as I did.And then it will just keep like propagating cuz the seeds kind of go everywhere and yeah,it's kind of fun.It's pretty.And it's medicinal.And I think you can eat the flowers too.I don't know.Yes you can.Yes you can.Oh,you can look at us.We're coming full circle.Look at us.Look at that.Throw'em out your salad.Yep.Feed'em to your chickens.You Yeah.Feed'em to your chickens.Yeah.It'll like give them nice bright colored yolks.And if you don't have chickens,feed'em to your neighbor's.Chickens.That's right.An exchange for eggs.Um,you know,we were talking about herbs.Another herb that I really like for people who have urinary issues after they complete mostly radiation.Mm-hmm.um,is uh,corn silk,corn,silk tea.So nice.Really soothing.Super soothing.There's nothing like it.Thing about corn silk is,there's not a great substitute.It's not like,oh,corn silk does the same thing as X,Y,and z herbs like corn silk is so unique with that soothing aspect of the urinary tract.The best way to get it,cuz it's,it actually most of my suppliers will often run out of the tea,is when corn is in season,go ahead and sh the corn and keep those nice silky hairs.Cause that's what corn silk is.It's just the silky hairs around the kernels,around the,the cob itself.And you can dry them and they work just as well dry as they do fresh and they last longer.Yeah.And yeah.Sweet corn season cuz it's not sprayed or anything.Mm-hmm.get the sweet corn.Yeah.And cuz I've done this before,the,the most convenient way to dry them is,you know,you carefully take a,a bunch of them off of their long strength and you kind of do what they do with,uh,Ling and you put it in a little circle on a,on a tray and just leave it there to,to dry somewhere clean.And where the wind is not gonna blow it away,so that way they're in round circles,so then you can just put it in a jar when you're all done.I'm likeI because the last time I made linguini was like I was a little kid and my dad and I made pasta,like Yeah,It's been a long time.Well,you buy it that way sometimes in the store.No,yeah,I know what you mean.Yeah.Okay.The,the fresh.Okay.So,um,moving on,there are also prescription medications,compounded medications that you can get,especially if you are having,um,a lot of chronic pain.And so,you know,talk to your doctor about,about those kinds of things.Let's talk about lingering pain,because you just mentioned it.Oh,lingering pain in general.Yeah.As opposed to like gynecologic or rectal pain.Yeah.So yeah,let's,let's,let's move on into to chronic pain.Yeah.If we're talking about collateral damage and quality of life on a day-to-day basis,pain is huge.Pain is up there.You know,we live in a day and age that no one should be having to live with pain.There should be something we can do with my patients if there's still pain,like there's gotta be someone else we can see something else that can be done.Physical therapy,I am a huge fan of physical therapy.Um,you know,obviously get evaluated first to make sure something else isn't going on,and then get that referral to physical therapy because I find,I mean,oftentimes the pain is directly related to the treatment,but I also find that the pain is related to,um,atrophy of the muscle.I mean,if you weren't as active during treatment,if you were sitting down or laying down a lot,there was a lot of deconditioning that happens.Mm-hmm.And then,you know,if I just think about like.Deconditioning of the glutes and you know,the,the lower body muscles is going to result in lower back pain.And so that chronic back pain you are having may be completely unrelated to the treatment itself.It's more.the damage from deconditioned muscles and just not using it while you're in treatment.Mm-hmm.And that can apply to anything like,I mean,just Right.So finding a good physical therapist who can provide an exercise program.Just don't go to physical therapy and do the exercises there and then go home and be like,I'm waiting for my next appointment.You gotta continue with those exercises.Right.you know,so important and I think what you prefaced this with before going into that,which is make sure there's nothing else going on first.Absolutely.And then go ahead and,you know,proceed.And if something is assumed to be a diagnosis,like for example,you know,your back pain acts up and you have reason to justify the fact that the back pain happened in the first place.Um,but you do the PT or you do whatever and it doesn't get better,always get reassessed.I think reassessments are important in the survivorship population,just to make sure,just gotta clear the slate,make sure nothing's going on,and then move on.Cause I've had a few.Folks who went too long,before being reassessed.Cause they just kind of wrote off their pain as part of just what happens post-treatment.And it ended up being something bigger.Right.And a really common source of pain are those anti hormone treatments,the aromatase inhibitors causing,you know,the,the joint pain.Um,that's more something I find that those patients,the pain is relieved with movement.Um,yes.And so exercise,you know,do you feel better when you exercise?Yes.Yeah.There was a study quite a few years ago now that showed that people on those,um,aromatase inhibitor drugs that,that block the production of estrogen and they.Skeletal pain,so muscle pain and,and joint pain and things like that.When they exercised,they still had some slight pain.It didn't like miraculously make them pain free,but they compared'em to a matched group who did no exercise and basically their pain just got worse and worse and worse over time.Sometimes it's won't,you won't be a hundred percent still because of your reaction to that particular drug,but exercise will still be doing you good even if you're not feeling like a million bucks and you're supporting bone density.Right.Osteopenia,osteoporosis,which we,we've talked about before,um,in our bone health episode.Yes.In our bone health.Yes.Um,yeah,I mean,that can improve with doing exercise.This should just be called the exercise episode,I'm thinking.Um,but,but Sure.Um,you know,you're re you're reducing your risk of fractures.Which is a whole nother Yeah,that's a good point.You know,concern that could happen.So,um,yeah,that's a good point.And you know,I think about naturopathically,I think of different.anti-inflammatories,as long as they're appropriate.If somebody is still taking certain medications,um,you know,medications,just that they even took before their cancer treatment.You know,you always wanna be careful with certain things and blood thinners,but I love those general anti-inflammatories,like I love boswellia.Mm-hmm.prolene combos of those things.Mm-hmm.good old turmeric.Yeah.And,and again,check to make sure that those are not gonna interact with treatments.Turmeric,I think of,we've talked about,you know,Tamoxifen is something that you don't wanna be taking turmeric pills,um,but you know,you could put you know,put it in your food.Mm-hmm.you know,ginger.Same thing with the ginger.Ginger root.Ginger's Great.Love ginger root.Yeah.Ginger.You could take it as a.As an anti-inflammatory capsule.It helps with digestion too.Um,but yeah,I,I would just have to,I have to round that out with fish oil as if we're,if we're mentioning pills that are anti-inflammatory,we have to say fish oil.Oh yeah.Oh yeah.Fish oil,Um,yes,definitely.And then plant-based,I mean,again,bringing that plant-based diet back into it,you know,just trying to eat overall a less inflammatory diet,less,um,refined carbohydrates,less refined sugar,and then I'm gonna push that back.That can also help endocrine wise in terms of like having those hot flashes and night sweats.Um,yeah.Helps with fatigue.Yeah.So it all kind of,it all comes together.There's a Venn diagram out there.Maybe we will create it,but there's a Venn diagram of like what these like.recommendations we make are,you know,it helps more than one thing,so,well,and as far as in infl,the inflammatory reaction,which will always make,well,almost always make pain worse.You know,most of the time it will make pain worse if you have inflammation in your system.A diet diary,just jotting down your pain on a day-to-day and what you eat on a day-to-day.And then looking back to see if there's any trends,patterns.Exactly.Because people will do that and they'll come back and say,oh,when I have corn mm-hmm.it makes it worse.Or whatever it might be.Yeah.It could be something so random.If I drink coffee,it's worse.I mean,yeah,it could be,like I said,random.Yep.And if your pain is pretty consistent,take out what you eat every day.Cuz there's some people like ate cheese every day,right?Oh,it can't be cheese.I eat it all the time.Exactly.You're like,yeah,but your pain is always there,so.Mm-hmm.um,Yeah,I hate to say that.And there,and there was an old time doc when I was training who just basically said,what are your favorite foods?What do you eat all the time?Stop eating them.He basically said,stop eating those and see what happens.Yes.I was like,oh no.Okay.That's really hard to do for folks though because,you know,food is comfort and there's all sorts of reasons we eat besides nutrition.I know,but you know,we're,we live in an age where there are alternatives to some of those foods.And so there are some great dairy-free products that,you know,one would eat in moderation and there are really good,um,there are really good gluten-free products or,you know,whatever you find is,is your trigger.And I know I have mentioned before that I worked with,um,a pain management doctor who was working with this one specific patient who it was so,so hard to manage their pain and he actually ended up recommending that,why don't you just try a gluten-free diet and see if that helped?And I think it helped a little bit,but it wasn't completely the full picture.So,and I'm not telling people to go gluten-free if they're in chronic pain.But Right.You know,it could just,it could be anything.Yeah.Yeah.That's why the diet diary is so handy because your options are,give up a whole bunch of stuff and see what happens.Or just jot it all down and if you ha if your pain ebbs and flows,I put money down that there's something in your diet making it worse sometimes.And I'm gonna also go back to hot flashes and say a diet diary is also good for that because I do find that there are food triggers,whether it's just,oh,it's that ice cream that I have every single night before I go to bed.Or,um,yeah,or something that maybe you're just sensitive to.So those diet diaries are,are a good thing.If you have a history of disordered eating though,I don't necessarily recommend doing a dietary,cuz it could be triggering.That's a good point.Have you,have you seen some of the research that talks about what's inhabiting our gut as in our bacteria and our fungus is,uh,dictating to our brains what we want to eat,what we want to eat?Yeah.Like they make metabolic byproducts and they,they're the,you know how there's a gut brain access,like there's a communication link between the gut in the brain?Yes.Well,Candida or yeast is,is one of the classic examples of that little critter in your gut when it's overgrowing and there's two bunch of,it sends off chemical messages that go to your brain and tell your brain to go and eat that sweet.So it's like,it's like,um,little Shop of Horrors.It's like,feed me Seymour.Yes.Feed me Seymour.Yes.Yes.So what is the,what,what is the gut bug that's telling me that I need to go have a little bit of dark chocolate It's some gut bug that who likes something in your chocolate?I don't know.Oh,I don't know.But maybe how exciting Doesn't mean it's an,it's a bad one,but you,you know,one of the classic examples of how the gut and the brain function together,and I'm bringing this up because sometimes it helps to think to yourself,oh no,Rather than thinking it's just you that wants that.You're like,wait a second,I'm not gonna give it to my Candida.I'm not gonna eat that sweet And it kind of like psychologically can help.Maybe eat well.But anyways,there's the classic,um,toxoplasmosis and,and rats thing.You know that story?No,I know that.You get toxoplasmosis from changing kitty lit.Yeah.And the way,one of the ways that cats are exposed to the toxo is,is the animal that it kills like a rat,for example.Well,it turns out toxo can live in the rat's brain and it gives messages to make it less fearful of felines so that it basically,the toxo wants to,wants to get into that cat.And by virtue of asking that rat,and I'm,I'm putting,asking an air quotes,you know,chemical,chemical messenger that says,you shouldn't be afraid of this feline.Go ahead and walk the gauntlet,and the feline jumps on the rat,or whatever that animal is,then the,the toxo gets where it wants to go,which is into the cat's body.So it's,it's,it's,it's all about the TOXs.You know,I,you know,I have this theory,right,Yes.We are controlled.Yeah,we are.It's like that,that,that,uh,creature from what was the,um,men in black,how it was looked like a person,but inside there was like this little alien.Like,we're just being controlled by Yes.Well,it's not,we're being controlled by aliens.known as gut microbiome.They're in,maybe they're not in control,but they're certainly influencing us in how we think in our mood and everything.So this is a great segue to go into digestive side effects that,are long-term.Mm-hmm.you know,oftentimes people are post-surgery,they have an ostomy bag,and so trying to manage the stool that comes through that.Um,so many patients say my digestive system has never been the same since treatment,whether they got,you know,a combination of chemoradiation or surgery.I mean,it's just,you know,someone said,and it's just so vivid in my mind,you know,about how,you know,they're.they had all these surgeries and like their guts were just moved around.Like it wasn't even GI surgeries.Right.Um,but you know,like they just talked about how that like I just don't feel like my digestive system has been the same.Mm-hmm.I've heard that many times too.So many times.That is a good segue into the GI because getting your microbes aligned and having good gut bacteria is all part of having good normal bowels.It has to do with whether you're constipated or have loose stools.It has to do with the function of the bowels.It has to bowel motility of the bowel.Like what inhabits your gut.And this is outside of any surgeries that may have removed parts of the digestive tract that are affecting,um,because that obviously has a huge influence,but it's more than just taking probiotics as well.I try to encourage people to do more of the plant-based fibers,diverse kinds of fibers.Um,and probiotics is kind of a case by case basis.Mm-hmm.because sometimes probiotics will make it worse,or if you switch the probiotic that they're taking to something else,it could make a whole,you know,a world of difference.Yeah.Probiotics are a bit of a catch22.I've,I've never been a huge fan unless there's a very good reason.there are select cases,but for most people,I don't keep them on a probiotic.I just don't keep them on one probiotic all the time.There is some evidence to show that whatever we give as a probiotic,think of it like seeding the soil,right?You're seeding the garden with these probiotics,and the probiotics then go to proliferate inside your gut,mostly your large intestine.That's where the most population is.There is the thought that the complexity of what's already there is simplified by taking,even if it has a dozen,I don't care if it has two dozen,there's hundreds,there's really thousands of species,hundreds of different types of bacteria in the gut.And so anything we take can have the danger of oversimplifying it.So you take what was a very complex ecosystem like I always picked on Mountain Meadow NA has created,and it's a super complex system of organisms,trees,and fungi and all that stuff.And you simplify it because you come through with a bunch of seeds that now overgrow it and it can't be as complex as it should be.So I've got a little hesitation to just consistently use a probiotic because I don't want to lessen gut diversity.Cuz diversity we know is a healthy thing.More diversity is better.Yeah.And encouraging people to eat probiotic rich foods.Again,I.in a part of the country where,you know,diversity in diet is not typical,so it is a bit more of a challenge,but whether having someone switch up their brands of probiotics,you know,kind of do different ones,um,trying to get that fiber in,whether it's,you know,ground flaxseed mm-hmm.um,if they're taking,if they're taking,uh,you know,cardiologists often recommend to take what is Metamucil,you know,that's illium,you know,just having these different kinds of fibers.Yes.The,the foods that the probiotics eat.The prebiotics.Right.Yeah.Because if we use the seed analogy,if you want more,I don't know,tomatoes to grow or corn to grow or whatever to grow,you don't throw more seed down.You,you make the soil better,right?So prebiotics are all those fibers and what are now popularly called undigestible starches.Right?These starches from legumes,even potato.sweet potatoes and potatoes have undigestible starches which go down into the colon and feed the gut bacteria.And that's good.We want those things.We wanna keep feeding them.We want the fertilizer for the good guys,but no,we don't necessarily wanna keep receding it cuz that doesn't make as much sense as fertilizing it in the grand scheme.So yes,it is more challenging where you are.You are in,I'm in America.No,I was gonna say Midwest.Technically.I'm in,I'm in.I'm between the coasts.Well that makes it mid,that's mid for sure.That's mid,yeah.Um,other issues with,the digestive tract,you know,going up to oral health.So,certain treatments can cause weaker teeth,enamel to come off.Um,vomiting.I mean just,just chronic vomiting can,you know,from treatment can cause.damage to the teeth.Radiation people have teeth,you know,teeth removed.Um,it's the dry mouth.I just think about people who have had radiation to the head and neck area.Mm-hmm.and having either chronic,you know,salvation.Mm-hmm.versus having just this dry mouth that is just unrelentless.One of the things I always think about when I'm seeing a patient with a symptom is what is the healing potential of that given tissue?And so oftentimes with head and neck,because they're going for a curative treatment,they will radiate,like you said,the bone can have effects even down the line because they'll radiate to the point where the bone in the jaw is no longer dynamic.It's no longer creating new bone and destroying old bone.Like that's what our bones are always doing day and night.We have dynamic process in our bone that leads to laying down new bone in our entire lives.So we chew up bone,we lay down bone.This is part of just our bone turnover.This is a natural process.Radiation.Can remove the ability to do that by destroying the bone to the degree where you can no longer lay down those new bone And if that's the case,then that ensuing years afterwards,can lead to damage and even have to replace the,the jawline.I've had several patients go through that,so there's a fix for it.But for us,what we would do for this process,we would support the bone But what I'm saying is,is there potential for the bone to be repaired?Is there any,uh,osteoblasts that are active in the bone?If it's to the point where the radiation was so severe,there's nothing left,then it may have to have a surgical intervention at some point.If there is some healing potential left,then we would support that with all the ways that we support bone health,which was a prior episode.But in short,vitamin D,vitamin K,enough calcium,magnesium,and other minerals in the diet to make sure the bone is healthy.but it's important to,to,in my thought process,thinking of chronic collateral damage,to always consider what is the healing potential of the given tissue that is damaged.Do we have healing potential?Is there damage that is beyond repair?So we've gotten all the way down to like stem cells or osteoblasts.In the case of the jaw,as long as there's potential,the body can do it and we can optimize that with herbs and nutrients and diet and such.But yeah,and sometimes it's just not going to gonna happen.I mean,just having.Chronic taste changes,you know,just the radiation was just so much.Yeah.I just kind of think about the limitations of what it is that we can do when trying to prevent these in the first place.Yeah.You know,if I could do one thing,it would be to get better studies within the cancer centers that shows what does or doesn't,prevent some of these long-term side effects.Because again,especially when there's cure on the table,long-term side effects are a distant second thought for most of the conventional care team.They're not really thinking about what's gonna be happening in five years with you or10years.they're thinking about the moment,can we get it all?Let's do that.Right.So it's it's understandable in real time and it sure would be nice to be able to prove some of the things that we know,or I believe cuz I've seen it in my patients,can lessen the risk of some of the long-term side effects.Ideally doing it during treatment,like we talked about in the side effects episode.Yeah.And then some things like,you know,what we covered in neuropathy episode,you can do everything that is out there to do that is safe to do during treatment and still come out with,with having long-term neuropathy.Mm-hmm.and I use myself as an example.I did everything possible and I still have,I mean it's,it's so much less.And then I ask patients because I find that doctors stop asking,and I'm the one who asks,are you experiencing neuropathy?Oh yeah.But.Don't worry about it like I'm used to it.Like they're just,they just get used to it.They write it off.But yeah,you can,you can do everything that is out there that is safe to do during treatment to try to ward off some of these side effects and they still can occur,so.Mm-hmm.um,that's a,that's a huge challenge.Mm-hmm.There are a lot more things that we can do naturopathically that aren't necessarily what we would use during treatment,but that can help to repair and lessen,the damage that has happened.Mm-hmm.and we talked about a lot of that in our peripheral neuropathy episode.Right.So I'm gonna re,I'll put that in the notes too.That was one of our more popular episodes,by the way.Well,because robin,these sucks if people are living with it.Yeah.Um,yeah,and there's no great,I mean,there's medications that can,you know,they,they do use,but Yeah.Normalcy,they're,they're not,yeah.The medications aren't addressing the healing aspect.Right.If there is healing that can happen.Um,the medications are just helping the person to cope.Mm-hmm.with the side effect.Um,that's how I see,I see.The prescription medications.And so taking those prescription medications and also doing naturopathic support using whether it's alpha lippo acid or,acetyl L carnitine,whatever it may be.but as long as there's no interaction,which I don't believe there are,um,you can do a multimodal treatment,right.Using the prescription medications as well as using naturopathic treatments.Right.You know,that.Calls to mind something.This is our,since this is our general episode and we're talking about various systems that need to be repaired,I wanna put out there just a general premise that is the faster the cells in a given tissue or organ system are renewed in healthy people,right?The faster that the,the turnover is,the faster that tissue repairs.So if,for example,you get chemotherapy and you have mouth sores,mouth sores,the turnover of your mucosal cells is rather quick.So as long as the damage isn't deep enough to affect,you know,the stem cells in there,you can have turnover and have rapid healing of the mouth tissue much more rapid than the nerves,for example.The cells do turn over.There's a very slow creation of new nerves and new nerve cells.And I'm saying this cuz there's a difference between,you know,wanting to support the liver,the kidneys,the heart,they all have turnover.All organ systems in the body are dynamic.We're constantly renewing our tissue.It will take longer with tissues that have slower cell turnover and it's faster with cells with faster turnover.It doesn't mean it happens,you know,in weeks or days.I'm just saying that nerves take classically years to repair.It's a take much longer than you know,the GI tract,which has a constant turnover.going off of that in terms of,you know,talking about nerve repair,I mean that's the same with memory.Mm-hmm.you know,and the,and the memory problems can continue to happen after treatment.And it's just this kind of like slow progression that can be related to what we were talking about,the h p a axis and stress.It could be related to so many different things.I mean,there was even that study saying that women who took probiotics during,chemotherapy for breast cancer had less complaints about their memory.But there you can retrain your memory,you can,you know,whether it's different apps.Um,there are supplements that you can take that can work on different,you know,aspects of memory.But,that definitely is something that it's work.I mean,just because it happened over the course of a few months doesn't mean it's gonna take that long to repair.It might take.a lot longer.And it's constant work.It's constantly exercising that brain.Yeah,because neuroplasticity is real.And that's the term we use for the ability to make new cells,new circuits and actually rewire your brain in a lot of ways.And it,and it's not age dependent.Yes,it's very plastic when you're young,cuz you're a little sponge.You can take in information and everything's,you know,clicking fast when you're young,but you still have neuroplasticity no matter what your age is.You could be80years old,it's still there.And what we try to do is help support that in every way.And now I'm gonna say it again.We have another episode on,you know,chemo brain,chemo fog and brain health.And so I'm just gonna refer folks to that for more information cuz we talked,add about this in depth and what people can do,including some of those apps that you mention.This is like,our best of this is like,well,it's interesting.Like I feel like,I feel like we,like we need like little clips from like previous ones,you know,like,like when,when like,sitcoms would have like a,a flashback episode.This is our flashback episode.It's interesting.Yeah.Cause we have talked about a lot of this.And like you said,this is also,there's another list being compiled of episodes we haven't done yet in depth than we need to do,which is that cardiovascular is high on the list because we've done one on fatigue as well.Yeah.And fatigue is one of,you know,that,that is probably one of the most common,um,side effects that I hear.Mm-hmm.people talking about.Like,it's just not being able to,to shake that fatigue,you know,for some people they bounce right back.Mm-hmm.and that's awesome.Yes.That's amazing.Um,and then there is the,the group of people that,that's still this lingering thing,but it,it,you know,we're so connected.All of our organ systems.And so getting your endocrine system checked,you know,checking your thyroid,checking your diet mm-hmm.seeing if there are foods that,you know,like the people who get the three o'clock crash and they have to have their caffeine and their sugar,you know,what's going on there.Mm-hmm.Um,yeah.Are you getting sleep?Are you getting enough sleep?You know,Well,you know,you know my rule,no matter what anyone tells me,if I see them yawning in front of me and they're like,no,I sleep pretty well.And they're like,yawn,but they're complaining of fatigue.I'm like,I don't think they're sleeping because yawning is pretty.Yeah.See,just saying it.so no,I was just about to yawn because talking about yawn,like if I see people yawn,I yawn.And then talking about yawning also makes me yawn.So um,I'm like,no,I totally slept last night.I slept great.I did.I really did.And I'm just about to like fighting a yawn cuz you talked about you're highly suggestive.I am.I am.Um,I'm trying to think of anything else.I guess weight issues is the other,oh,thing that I hear from patients.Mm-hmm.and that,again,is really complex.Is it because of changes in diet?Is it because changes in hormones,changes in,you know,is it because of fatigue and,and you know,pain and inability to,to exercise or move?Um,is it changing your workout?Uh,maybe not focusing on that cardio and getting some weight training in there.Yeah,it's interesting cuz I think that sometimes people get very bad advice during treatment too,which is,you know,just eat for calories.Um,right.And,you know,that might be the case if you are completely depleted and your,you know,BMI is really low and calories have to go in.It's kinda like,I have an analogy.It's like if you're gonna drink water,drink good clean water,right?If you're in a desert and there is no water,then yes,you come upon whatever water you,you're gonna drink it.So there is a point in the weight loss kind of trajectory where it's like any calories is a good thing because you're not getting enough calories in,in general.But as long as you can get enough calories in general,then you should be pickier and you should eating nutritious food.And so that whole a calorie as a calorie go through the drive-through and just keep pounding them during treatment is advice people still get today.yeah,I've heard.eat candy bars,eat ice cream,whatever.And this is for somebody who might take that advice and run with it,right?I mean,sure.You know,you can,you can eat a lot of calories and still eat healthfully.You can make healthy,high calorie choices.Mm-hmm.I guess,is it like,you know,eating,people think eating healthy,you know,you're gonna lose weight.And I've had people say that to me before,like,well,you know,this isn't about me losing weight.And I'm like,no,I'm,I'm having you eat healthfully for the nutrients.Right?Like,the weight isn't what I'm focusing on.Mm-hmm.Um,and that's,you know,there is that whole movement fit at any size or something like that,which has to do more with composition.So I think when we do that,and I,I think we should do a,a whole episode on this.I think that composition is key.So how much muscle relative to how.Fat is on someone's body is probably more relevant than their overall weight.Right.And that was something we had mentioned in an there,I don't remember which episode it was,but um,we talked about how people could be skinny fat mm-hmm.um,where they just have more fat than muscle.yes.So yeah,getting that,that weightlifting and I,we have an exercise,um,program for,specifically for our patients at the cancer center.And I sent some patients over who are like,I work out all the time and I just can't lose this weight.And I'm like,well,maybe.You need to switch your work app,let's send you over there.And yeah,they're given like a different program from what they're,they're used to doing.It's like if you get in this rut and you're constantly like running on the treadmill,you're not gonna lose weight.but your body's been through a lot,so.Yeah.And especially if that,if the,if steroids are part of the treatment,that makes it a little tougher too,because there's a certain type of fat and areas of weight gain with steroids that are just different than normal weight gain.And then part of,I wanna say like the,the weight side effect is,also one's body image,which,say it again.It's a whole episode on its own because the,the effects of treatment.Um,skin tone changes,you know,skin,um,I should say elasticity will change.Mm-hmm.um,Body composition changes because maybe someone has been put into menopause.Um,surgeries will change your body whether you're actually having a body part removed or just scars themselves.Um,that is a really,really big,long-term side effect that I don't know if a lot of people do talk about.No,I don't think it is talked about a lot.Mm-hmm.because there might not be any issues with weight,but somebody just looks and feels different than what they were before treatment.Mm-hmm.and it's valid.Mm-hmm.you can't just be like,oh,well,you know,you're still alive.You know,be grateful.You're,you know,you're here to talk about it.Okay.Yeah,sure,that's true,but I'm not feeling the same.Right.I'm not looking the same.I'm not.And we're not,we are not the people we were before treatments started and.it's a fight to try to get past that because this is what I've experienced and I refuse to say like the new normal,screw that.Right.Um,some people are okay with that.I was not okay with a new normal,and I did fight it for a long time.Um,and I'm still kind of dealing with it.You mean the term new normal or just feeling like there's no,there's no potential to get back to,there's no potential to get back to where I was.I mean,I'm also considerably older.Uhhuh like I went through treatment almost nine years ago.Well,yeah.Yeah.Next year will be10years.Okay.When I started treatment.So I would've aged10years anyways.But obviously the treatment has affected me in ways where,um,maybe things would've happened a little slower instead of overnight.Mm-hmm.Um,but no,I,I struggle with,yeah.There's no returning to who I was before.Emotionally or physically.Mm-hmm.um,yeah.It's just,it's just not talked about.Yeah.Because you're expected to,you're expected to put on a smile,put on a happy face,get out there.you're,you're done with treatment,you're alive.Yay.Yeah.Yeah.And well,and people look at you and they don't,you look like Leia.Right.I mean,they don't see it.You feel what you feel,but on the outside no one recognizes it or has any acknowledgement.Yeah.Cuz I have hair,I have eyebrows,like I look like right now.Yes.What people think.I look like but I don't look like what I think I look like.Um,yeah.So there,there are a lot of body image issues.Yeah.Yeah.We need to find an expert to help us with this.I agree.I think that,you know,in.Yeah,I think we do need to find expert outside advice to see how to best deal with that and everyone's experience is so,so different.I mean,there's,the,the variety of reactions out there is more than,I mean,I'm not equipped.I just listen.I mean,that's my job.So I don't that I,I do a lot of biochemistry,fix it,but that's psychological.So I don't go in,I don't go into fix it mode.Yeah,it is,it is really hard.It is a lot of listening.Um,yeah,because yeah,there are PE people who are totally fine.They're like,Nope,my life,it's back to normal.I'm good.And then there are those of us who are like,yeah.Mm-hmm.All right,we'll put that under our future episodes.I got,I have Le Leia gets therapy.I don't the next episode.of the Cancer Pot.I love it.Um,or if you're an expert,like,like if this is your Yeah.Your.Your domain.If this is your,your expertise,please reach out.I guess we could say that about any one of these things that we've talked about.If you know,this is your forte,if you are a therapist or a physical therapist or a cardiologist or,or you've worked with someone who has helped you,you're a listener and you're like,oh,I know I worked with someone and they helped me a lot,and let us know.Yeah.Let us know.We're open,we're open to learn.We are open to learn.We like meeting new people.So are,are we,are we gonna be wrap?I guess we'll be wrapping this up.We should be wrapping this up,but we do have,do we have anything else that we wanted to mention?Oh boy.There's so much to talk about.Leia.I don't know.I know we like,I feel like we could keep going and it's,we could be like a one of three hour am radio shows Now it's serious satellite.But when we were growing up,they would just chat all night long and da da da.We could,but we will not do that.And then,and do a musical break now.Let's,you know,listen to a little e l o.We'll be right back.um,We have a new comment from a listener.Do you want me to read it?Yeah.All right.All right.This was on Apple Podcast review,so thank you.And a shout out to,I don't know how to pronounce this,or even if I'm supposed to pronounce it or if it's an acronym,but A L C I O K A T I O,which reads as El c Kio El C Cayo.I don't know,but thank you for this lovely comment.L C O wrote,I love this podcast.It feels like I'm sitting in their kitchen with them.So comfortable as a cancer patient,I can pull useful or helpful information from nearly every episode.Thank you both.Oh,that's awesome.I love that.Cuz I think sometimes we I feel like I'm just talking into,um,The ether.And so I'm glad that there's something in every episode that can be helpful to people.Yes,we strive to do that.So,um,we are slowly but surely growing as a podcast and our followers are growing.So if you're listening to us and you've found any of this useful,please hit that follow button and check us out online or whatever platform you're listening on.If you can leave a comment,please do so.That does help us,um,get found by others who we can help.Yeah.And share the episode with friends or family who might benefit from it.If you're on social media and you follow us,the Cancer Pod,um,is our name at the cancer pod,whether it's on Twitter or Instagram or Facebook.and we've always had buy me a coffee as a way that people can donate.And we've had many people generously donate to buy me a coffee.We now have a new link right next to it in our episode notes that just says subscription.You click on it for as little as$3a month.it's almost like a tip jar.That's what it feels like.I feel like I'm back as a barista.And there's a tip jar that,uh,people can just do the$3a month and just call it a day in what we were doing with our podcast,and this is a,a big reason that we're doing it is generally speaking,naturopathic oncology experts,naturopathic doctors who do oncology,are not in your cancer centers.And this podcast is our effort to reach people who can otherwise not get this information because it's unaffordable in the private sector.So I mean,the idea here is,um,To reach enough people that we can keep doing this podcast.And,uh,so yeah,any,any donations are welcome.What I need to mention before it's mentioned again in our outro,is that this is not medical advice.Everybody is an individual.Um,if we do say something that.is,you know,you're like,oh,maybe that'll work for me.Well check with your doctor or try to find a board certified naturopathic oncology provider.So on that note,I'm Dr.Leia Sherman.And I'm Dr.Tina Kaser.And this is the Cancer Pod.Until next time,Break it down,break it down.